Did you know that according to an IFOP study in January 2021, 19% of French women would like to give birth at home, and 17% are seriously considering home birth? What about you? Did you wonder about the place of birth when you were pregnant or for a future baby?
Home or home birth:
First of all, you'll need to find a midwife. At the start of this article, I said that 36% of women plan to have a home birth, but only 0.5% are able to do so, due to a shortage of midwives. So it's important to find out early on. More and more women are choosing a home birth midwife for their gynaecological check-up, so a link has already been established and if there are any contraindications linked to your state of health, you will be informed and guided as best you can to consider an alternative or implement corrective measures where possible.
Once the midwife has been found, the follow-up will depend on your aspirations as a couple - from the most natural to the most medical - and the progress of the pregnancy. It begins with an interview, ideally with the couple and before the 3rd trimester, to give you all the information you need to confirm your choice, answer all your questions and understand your project. The guiding principle of an AAD accompaniment is to encourage the conditions for a physiological birth, both medically and psycho-emotionally. So you'll alternate between moments that are more in the nature of clinical pregnancy monitoring, and others that will help you progress and prepare for the birth.
How many women actually give birth at home?
88% of women who go into labor at home have a trouble-free birth. When it's a second child or more, the risk of transfer is divided by 5! Most women who are transferred will do so without urgency, simply returning to the maternity hospital where they were registered. 1% of transfers require an EMS (emergency medical service), most often following a haemorrhage. It is also to avoid these rare and urgent cases that your midwife regularly assesses your state of health, and that we sometimes refuse to accompany certain families.
And if I'd given birth in hospital, would I have had less risk of complications?
No more, no less, according to international studies, and even a reduced risk of undergoing surgery. To give just a few examples, the 0.3%episiotomy rate for AAD versus the 20.1% rate for hospital birth, the 1% severe delivery hemorrhage rate versus 1.8%, the 2.2% cesarean section rate versus 20.4% and the 1% neonatal resuscitation rate versus 6.3% all confirm the legitimacy of this method of childbirth in France.
However, for rare cases requiring urgent intervention, not being in hospital increases the time needed to access advanced care. Your midwife will of course be able to initiate the first steps and stabilize the situation, thanks to her skills and equipment (oxygen, respiratory insufflator, anti-hemorrhagic drugs, perfusion or suture sets...). You'll need to weigh up all aspects of your decision carefully, and take the time to get a feel for the one you feel most aligned with.
The advantages of home birth:
There's no one ideal birthing place for every woman. It's up to each woman to find where she feels both physically and emotionally safe. Home birth accompanied by a midwife, which is the subject of this post, has the advantage of bringing the two together. In a way, it's a middle way, between giving birth alone in a secluded place for intimacy and "giving birth" under the control of machines and drugs for safety. Let's be careful not to caricature either: birthing centers and certain maternity teams can also be places of compromise. However, they remain "places where you go" and not the mother's familiar space.
The big day has arrived. How does a home birth work?
Imagine you're having contractions, and you can feel that today is the big day. You tell your midwife, she gives you some advice if you need it and gets ready. All you have to do is let yourself slip into labor, surfing the contractions without asking yourself any logistical questions.
Do you have to turn your home into a hospital branch, tarpaulin and disinfect the premises?
Not at all! At the end of the 8th month, your midwife came to your home and advised you on how to prepare it. Nothing complicated: protect the mattresses, bring plenty of towels and go to the chemist's to pick up a few products. So everything, or almost everything, is ready.
Can seniors attend the birth at home?
Here again, zero stress! It's nighttime and they're asleep, so leave them in bed to discover baby at breakfast for a wonderful family moment. During the day, some may want to stay and watch the birth, while others may prefer to go and play with grandparents, a friend, or go to school. For the older ones, talk to them beforehand, and explain to the little ones with books dedicated to home birth. In any case, make sure you have a plan B for baby-sitting, in case you need to go to hospital.
Who can attend a home birth?
It's up to you to decide who you want at your birth. Once again, you're at home. Just bear in mind that whoever attends, you'll need to be intimate enough with her to dare to be naked in front of her, defecate or show yourself as vulnerable as cro-magnon. It may sound crude, but if it's not, it could inhibit your delivery. Ideally, everyone involved should have met at least once beforehand to agree on their respective roles and provide you with the best possible support. And don't forget that intimacy often rhymes with small, or even very small, groups.
What happens at the moment of birth?
Let's go back to our visualization: labor is now intensifying, so there's no need to worry about knowing when to go, just call your midwife. She knows you, knows how you work, and will join you when the time is right. While you're waiting for her, you can take a bath, relax in your own environment, curl up in your partner's arms or shut yourself away in the garden. You're at home, so anything's possible - it's up to you.
Your baby's labor and well-being are monitored non-invasively, and when he starts to push, we let you accompany him in your own way. You choose the position, the rhythm, the place and welcome your baby with your own hands. Now all you have to do is enjoy.
It's a beautiful vision, but is it always as simple as that?
As you'd expect, no. Midwives haven't existed in every civilization for nothing. While in most cases, women have all the instincts and feelings within them to do it without any intervention, sometimes Mother Nature has a whim.
And what about after the birth? Still no doctor?
Your midwife will stay 2 to 6 hours after the birth to accompany you, take care of you and make sure everything's going well. When she leaves, she'll give you your baby's health record, birth certificate, delivery report and other useful documents. She or one of her colleagues, depending on your plans, will visit you the next day, then at least on day 3 for the Guthrie test and on days 5 and/or 10. The medical examination on day 8 is carried out by a doctor, and a certificate is drawn up. This may be your general practitioner who comes to your home, or a pediatrician you consult at his or her practice or at the maternity hospital.
With no break or change of environment, the baby adapts easily to his new life, and breastfeeding is often easier. The bond with co-parents and siblings is also stronger.
Why do we wonder about the best birthplace for us?
Childbirth is an intimate, instinctive process controlled by our reptilian brain - the instinctive brain. From this we might conclude that women should give birth in a familiar place, with few people, so they can give in to their "wild woman" instincts. We know that the reptilian brain is inhibited by the neocortex, which in turn is stimulated by anything that gives pause for thought (when to leave, answering hospital admission questions, hearing the sound of machines...). In short, we can conclude that the hospital chosen by the majority of women is not really suited to the experience of childbirth.
And yet, unlike the lioness or the gazelle, we are eminently cultural female mammals. As such, we are imbued with the beliefs of our society and times. So for some women, the place where they can most surely let go is where they have access to a whole host of technology and a plethora of tests. With these interventions, they can stop thinking and worrying and let themselves go into contractions and openness, feeling safe and "taken care of".
Also, there is no one ideal birthing place for all women. It's up to each woman to find a place where she feels both physically and emotionally safe.
So, finally, what would be your choice?
To find out more, contact APAAD or CDAAD. Remember, there's no right or wrong way to give birth. There's what you can do, depending on your medical and emotional background, and on how your pregnancy and childbirth unfold. But one thing's for sure: if you've given yourself the means to experience what you hope for, and you've remained an active participant, whatever happens, you'll be at peace with your decisions. So, whether or not to go ahead with a DAA, the choice of where and how you want to have your baby is an essential one.
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Article written by Floriane Stauffer-Obrecht, AAD midwife and co-director of APAAD.
